Androgen Deprivation Therapy for Prostate Cancer Influences Body Composition Increasing Risk of Sarcopenia

Abstract

Computed tomography (CT) scans used in treatment response assessment in prostate cancer (PCa) patients are a useful tool for nutritional status evaluation. The aim of this study was to assess the nutritional status, including sarcopenia development based on CT scans, in PCa patients and its association with progression-free survival (PFS). Sixty-four PCa patients were included (group 1: 34 patients undergoing androgen deprivation therapy (ADT) with docetaxel due to newly diagnosed, hormone-sensitive, metastatic PCa and group 2: 30 patients with castration-resistant metastatic PCa continuing ADT therapy with enzalutamide or abiraterone acetate). Nutritional status was evaluated with anthropometrical parameters, Nutritional Risk Score (NRS), and CT scans at the L3 vertebrae. Survival analyses were performed. According to NRS, nutritional status was significantly related to PFS. In both groups, there was a significant reduction in muscle tissue (total muscle tissue and skeletal muscle index). A significant increase in the distribution of adipose tissue (subcutaneous fat, visceral fat, subcutaneous adipose tissue index, and visceral adipose tissue index) in group one was observed. Sarcopenia was diagnosed in patients but with no influence on PFS. Significant reduction in muscle mass and increase in fat mass was observed in patients treated for PCa with no impact on PFS. The NRS was related to PFS in PCa patients and associated with body composition, assessed by CT after the castration therapy. Long-term castration combined with abiraterone therapy with prednisone or enzalutamide significantly influenced muscle tissue and may lead to sarcopenia development.

Influence of Androgen Deprivation Therapy on the Development of Sarcopenia in Patients with Prostate Cancer: A Systematic Review

“…The description of included studies is presented in Table 1 . Observational studies were conducted in ethnically diverse groups of PCa patients, where the sarcopenia was assessed either twice (at the baseline and in the follow up) [ 22 , 23 , 25 , 26 , 27 ] or only once during the ADT treatment [ 28 , 29 ]. The largest group of PCa patients was found in Chiang et al [ 25 ] and therefore this study will have the greatest impact on the meta-analysis performed.…”

“…In most of the PCa patients, the median Gleason score was 8, indicating high-grade cancer ( Table 2 ). Patients were on different treatment regimens using ADT, where the ADT duration was reported in four studies [ 26 , 27 , 28 , 29 ] and dietary counselling was incorporated in the treatment in only one study [ 22 ] ( Table 3 ). Taking into account selected body composition parameters, an increase in SATI and VATI with a decrease in SMI and SMD over the course of ADT was observed ( Table 4 ).…”

“…However, the sarcopenia assessment methodology and time to follow up used in single studies were differentiated, which could influence the obtained results. Nevertheless, no association with progression-free survival or overall survival was indicted [ 22 , 23 , 25 ]) ( Table 5 ).…”

“…The major role is noticed on testosterone secretion that controls muscle volume and strength in men, and which is significantly decreased during ADT treatment [ 32 ]. The development of sarcopenia, understood as a decreasing amount of muscle mass or a decline in muscle quality [ 22 ], is a particular problem affecting people with chronic diseases. This applies not only to the group of men suffering from PCa and treated with ADT, but also to patients who suffer from, i.e., chronic obstructive pulmonary disease (COPD) or chronic liver disease (CLD) [ 33 , 34 ].…”

“…The fixed-effect or random-effect model was chosen. Korczak et al [ 22 ] and Sheean et al [ 23 ] presented data for two different populations independently (patients with hormone-sensitive prostate cancer (HSPC) or castration-resistant prostate cancer (CRPC) and Black or non-Black patients, respectively). Therefore, each population was considered separately in the meta-analysis.…”